Habitual short sleepers with pre-existing medical conditions are at higher risk of Long COVID

Linor Berezin; Rida Waseem; Ilona Merikanto; Christian Benedict; Brigitte Holzinger; Luigi De Gennaro; Yun Kwok Wing; Bjørn Bjorvatn; Maria Korman; Charles M Morin; Colin Espie; Anne-Marie Landtblom; Thomas Penzel; Kentaro Matsui; Harald Hrubos-Strøm; Sérgio Mota-Rolim; Michael R Nadorff; Giuseppe Plazzi; Catia Reis; Rachel Ngan Yin Chan; Ana Suely Cunha; Juliana Yordanova; Adrijana Koscec Bjelajac; Yuichi Inoue; Yves Dauvilliers; Markku Partinen; Frances Chung

doi:10.5664/jcsm.10818

Habitual short sleepers with pre-existing medical conditions are at higher risk of Long COVID

J Clin Sleep Med. 2024 Jan 1;20(1):111-119. doi: 10.5664/jcsm.10818.

Authors

Linor Berezin¹, Rida Waseem¹, Ilona Merikanto², Christian Benedict³, Brigitte Holzinger^{4

5}, Luigi De Gennaro^{6

7}, Yun Kwok Wing⁸, Bjørn Bjorvatn^{9

10}, Maria Korman¹¹, Charles M Morin¹², Colin Espie¹³, Anne-Marie Landtblom^{14

15}, Thomas Penzel¹⁶, Kentaro Matsui¹⁷, Harald Hrubos-Strøm^{18

19}, Sérgio Mota-Rolim²⁰, Michael R Nadorff²¹, Giuseppe Plazzi^{22

23}, Catia Reis^{24

25

26}, Rachel Ngan Yin Chan⁸, Ana Suely Cunha²⁷, Juliana Yordanova²⁸, Adrijana Koscec Bjelajac²⁹, Yuichi Inoue^{30

31}, Yves Dauvilliers³², Markku Partinen^{33

34}, Frances Chung¹

Affiliations

¹ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
² SleepWell Research Program, Faculty of Medicine, University of Helsinki, Orton Orthopaedics Hospital, Helsinki, Finland.
³ Department of Pharmaceutical Biosciences, Molecular Neuropharmacology, Uppsala University, Uppsala, Sweden.
⁴ Institute for Consciousness and Dream Research, Vienna, Austria.
⁵ Medical University Vienna, Postgraduate Master Program Medical Sleep Coaching, Vienna, Austria.
⁶ Department of Psychology, Sapienza University of Rome, Rome, Italy.
⁷ IRCCS Fondazione Santa Lucia, Rome, Italy.
⁸ Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
⁹ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
¹⁰ Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.
¹¹ Department of Occupational Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel.
¹² Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada.
¹³ Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
¹⁴ Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden.
¹⁵ Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
¹⁶ Sleep Medicine Center, Charite University Hospital Berlin, Berlin, Germany.
¹⁷ Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.
¹⁸ Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway.
¹⁹ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
²⁰ Brain Institute, Physiology and Behavior Department, and Onofre Lopes University Hospital Federal University of Rio Grande do Norte, Natal, Brazil.
²¹ Department of Psychology, Mississippi State University, Starkville, Mississippi, Mississippi.
²² IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
²³ Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
²⁴ Universidade Católica Portuguesa, Católica Research Centre for Psychological Family and Social Wellbeing, Lisbon, Portugal.
²⁵ Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisboa, Portugal.
²⁶ Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
²⁷ Medical College, Potiguar University, Natal, Brazil.
²⁸ Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria.
²⁹ Institute for Medical Research and Occupational Health, Zagreb, Croatia.
³⁰ Department of Somnology, Tokyo Medical University, Tokyo, Japan.
³¹ Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan.
³² Sleep-Wake Disorders Center, Department of Neurology, Guide Chauliac Hospital, Institute for Neurosciences of Montpellier INM, INSERM, University of Montpellier, Montpellier, France.
³³ Department of Clinical Neurosciences, University of Helsinki Clinicum Unit, Helsinki, Finland.
³⁴ Helsinki Sleep Clinic, Terveystalo Healthcare Services, Helsinki, Finland.

PMID: 37858285
PMCID: PMC10758549 (available on 2025-01-01)
DOI: 10.5664/jcsm.10818

Abstract

Study objectives: Preliminary evidence suggests that the risk of Long COVID is higher among people with pre-existing medical conditions. Based on its proven adjuvant role in immunity, habitual sleep duration may alter the risk of developing Long COVID. The objective of this study was to determine whether the odds of Long COVID are higher among those with pre-existing medical conditions, and whether the strength of this association varies by habitual sleep duration.

Methods: Using data from 13,461 respondents from 16 countries who participated in the 2021 survey-based International COVID Sleep Study II (ICOSS II), we studied the associations between habitual sleep duration, pre-existing medical conditions, and Long COVID.

Results: Of 2,508 individuals who had COVID-19, 61% reported at least 1 Long COVID symptom. Multivariable logistic regression analysis showed that the risk of having Long COVID was 1.8-fold higher for average-length sleepers (6-9 h/night) with pre-existing medical conditions compared with those without pre-existing medical conditions (adjusted odds ratio [aOR] 1.84 [1.18-2.90]; P = .008). The risk of Long COVID was 3-fold higher for short sleepers with pre-existing medical conditions (aOR 2.95 [1.04-8.4]; P = .043) and not significantly higher for long sleepers with pre-existing conditions (aOR 2.11 [0.93-4.77]; P = .073) compared with average-length sleepers without pre-existing conditions.

Conclusions: Habitual short nighttime sleep duration exacerbated the risk of Long COVID in individuals with pre-existing conditions. Restoring nighttime sleep to average duration represents a potentially modifiable behavioral factor to lower the odds of Long COVID for at-risk patients.

Citation: Berezin L, Waseem R, Merikanto I, et al. Habitual short sleepers with pre-existing medical conditions are at higher risk of long COVID. J Clin Sleep Med. 2024;20(1):111-119.

Keywords: COVID-19; ICOSS II; International COVID Sleep Study Survey; long COVID; pre-existing medical conditions; sleep duration.

MeSH terms

COVID-19* / epidemiology
Humans
Post-Acute COVID-19 Syndrome
Preexisting Condition Coverage
Sleep
Sleep Wake Disorders* / complications
Sleep Wake Disorders* / epidemiology